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SIBO: pathogenic or non-pathogenic bacteria?

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#1 Alec

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Posted 08 June 2011 - 01:06 AM

Most of the information that I've read about SIBO says that it's because of friendly non-pathogenic intestinal bacteria usually found in the colon that's populating the small intestine. But so many people take probiotics with meals and don't have the gas and bloating that people with SIBO have. So it's made me wonder if it's pathogenic bacteria instead.

Edited by Alec, 08 June 2011 - 01:12 AM.

#2 Alec

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Posted 23 February 2012 - 10:21 AM

I'm now almost convinced that it's mostly overgrowth of pathogenic bacteria instead of bacteria like acidophilus or bifidobacteria that cause the negative symptoms in SIBO. Any thoughts are welcome.

The Prevalence of Overgrowth by Aerobic Bacteria in the Small Intestine by Small Bowel Culture: Relationship with Irritable Bowel Syndrome.
Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, Pimentel M.
SourceDepartment of Gastroenterology, Sismanogleion General Hospital, Athens, Greece.

OBJECTIVES: Many studies have linked irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO), although they have done so on a qualitative basis using breath tests even though quantitative cultures are the hallmark of diagnosis. The purpose of this study was to underscore the frequency of SIBO in a large number of Greeks necessitating upper gastrointestinal (GI) tract endoscopy by using quantitative microbiological assessment of the duodenal aspirate.

METHODS: Consecutive subjects presenting for upper GI endoscopy were eligible to participate. Quantitative culture of aspirates sampled from the third part of the duodenum during upper GI tract endoscopy was conducted under aerobic conditions. IBS was defined by Rome II criteria.

RESULTS: Among 320 subjects enrolled, SIBO was diagnosed in 62 (19.4%); 42 of 62 had IBS (67.7%). SIBO was found in 37.5% of IBS sufferers. SIBO was found in 60% of IBS patients with predominant diarrhea compared with 27.3% without diarrhea (P = 0.004). Escherichia coli, Enterococcus spp and Klebsiella pneumoniae were the most common isolates within patients with SIBO. A step-wise logistic regression analysis revealed that IBS, history of type 2 diabetes mellitus and intake of proton pump inhibitors were independently and positively linked with SIBO; gastritis was protective against SIBO.

CONCLUSIONS: Using culture of the small bowel, SIBO by aerobe bacteria is independently linked with IBS. These results reinforce results of clinical trials evidencing a therapeutic role of non-absorbable antibiotics for the management of IBS symptoms.

Invited review: the scientific basis of Lactobacillus acidophilus NCFM functionality as a probiotic.
Sanders ME, Klaenhammer TR.
SourceDairy and Food Culture Technologies, Littleton, CO 80122-2526, USA. mesanders*msn.com

Lactobacillus acidophilus NCFM is a probiotic strain available in conventional foods (milk, yogurt, and toddler formula) and dietary supplements. Its commercial availability in the United States since the mid-1970s is predicated on its safety, its amenability to commercial manipulation, and its biochemical and physiological attributes presumed to be important to human probiotic functionality. The strain has been characterized in vitro, in animal studies, and in humans. NCFM is the progenitor of the strain being used for complete chromosome sequencing and therefore will be a cornerstone strain for understanding the relationship between genetics and probiotic functionality. Both phenotypic and genotypic techniques have verified its taxonomic status as a type A1 L. acidophilus strain. It adheres to Caco-2 and mucus-secreting HT-29 cell culture systems, produces antimicrobial compounds, and is amenable to genetic manipulation and directed DNA introduction. NCFM survives gastrointestinal tract transit in both healthy and diseased populations. NCFM inhibits aberrant crypt formation in mutagenized rats, indicative of activity that could decrease the risk of colon cancer. A blend of probiotic strains containing NCFM decreased the incidence of pediatric diarrhea. NCFM led to a significant decrease in levels of toxic amines in the blood of dialysis patients with small bowel bacterial overgrowth. At adequate daily feeding levels, NCFM may facilitate lactose digestion in lactose-intolerant subjects. Further validation of the probiotic properties of NCFM in humans and clarification of its mechanisms of probiotic action are needed to better understand the role this strain might play in promoting human health.

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#3 Alec

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Posted 23 February 2012 - 12:08 PM

Small intestinal bacterial overgrowth (SIBO) is a common cause of chronic diarrhea. Small intestinal bacterial overgrowth results from colonization of the proximal small bowel by gram-negative aerobic and anaerobic bacteria that are normally restricted to the colon or, less frequently, from overgrowth of oropharyngeal flora.


Edited by Alec, 23 February 2012 - 12:11 PM.

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#4 CaptainFuture

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Posted 23 February 2012 - 06:26 PM


I don't know how probiotics help with SIBO but Rifaximin seems to be a very good treatment option:




Rifaximin is a broad-range, gastrointestinal-specific antibiotic that demonstrates no clinically relevant bacterial resistance. Therefore, rifaximin may be useful in the treatment of gastrointestinal disorders associated with altered bacterial flora, including irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO).
To review rifaximin for treatment of IBS and SIBO.
Review of rifaximin clinical trials.
Rifaximin improved global symptoms in 33 - 92% of patients and eradicated SIBO in up to 84% of patients with IBS, with results sustained up to 10 weeks post-treatment. Rifaximin caused a lower number of adverse events compared with metronidazole or levofloxacin and may have a more favorable adverse event profile than systemic antibiotics, without clinically relevant antibiotic resistance.

PMID: 19243285 [PubMed - indexed for MEDLINE]


Results from the present study show that higher doses of rifaximin (1200 mg/die) were associated with a significantly higher therapeutic efficacy in terms of SIBO eradication with respect to doses of 600 and 800 mg/day.

On the basis of the available literature, the 7 days - 1200 mg rifaximin therapy is a good option in terms of efficacy and tolerability for SIBO treatment.

Edited by CaptainFuture, 23 February 2012 - 06:28 PM.

#5 Alec

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Posted 24 February 2012 - 11:18 PM

There is some of positive information on rifaximin and its use for bacterial overgrowth. There's also the possibility that it could wipe out some of the friendly microflora that's already providing protection. I suppose that could be balanced off with administration of probiotics containing lactobacillus and bifidobacteria during or after the treatment.

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#6 Hip

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Posted 27 December 2012 - 07:28 AM

Your dividing bacteria into pathogenic and non-pathogenic species is not entirely correct. Some bacteria are considered non-pathogenic in the intestines when their population is small, but pathogenic when they grow in number. This third category you can term "potential pathogens".

Staphylococcus aureus and Proteus mirabilis are examples of potential pathogens: bacteria that are pathogenic when their population grows too large.

I suspect that SIBO problems may arise when potential pathogens in the gut grow in number. The cause of this unchecked bacterial growth may be due to immunosuppression. Immunosuppression can arise from certain chronic viral infections; enteroviruses are pretty immunosuppressive, for example.

So even if you kill of the bacterial overgrowth of SIBO, it may return again because of the immunosuppression.
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